Utilization Review Clinician – ABA

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Conduct assessments of members' healthcare and well-being for Applied Behavioral Analysis (ABA) services to assess medical necessity.

• Oversee the clinical effectiveness and efficiency of members' care in line with ABA guidelines.

• Review members' care and health status prior to, during, and following ABA services.

• Execute prior authorization assessments pertaining to behavioral health.

• Examine behavioral health member data to enhance quality and proper use of services.

• Communicate with behavioral health providers regarding the level of care and services rendered.

• Inform members and their families about ABA and the processes for utilizing behavioral health services.

• Provide insights to leadership on opportunities for improving care services.

• Assist in process enhancements and the creation of new procedures and policies.

• Adhere to all established policies and standards.

• Undertake other responsibilities as assigned.

⛳️ Requirements

• Must be able to work within the Eastern or Central Time Zone.

• Active BCBA certification is mandatory.

• One of the following licenses or certifications is required: LCSW, LMHC, LPC, LMFT, LMHP, or RN with state licensure and/or compact state licensure.

• Graduate of an Accredited School of Nursing or possess a Bachelor's degree with 2-4 years of relevant experience.

• Minimum of 2 years providing ABA services as a BCBA for Enterprise Population Health.

• Independent practice license and/or state-required licensure as specified by the applicable state (BCBA) is essential.

• A Master's degree is necessary for behavioral health clinicians.

• Clinical knowledge of behavioral health and the capability to review and/or evaluate ABA Treatment Plans is required.

• Familiarity with ABA services and the BH utilization review process is essential.

• LCSW, LMHC, LPC, LMFT, LMHP, or BCBA certification is required.

• RN state licensure and/or compact state licensure along with BCBA certification is required.

• Licensed Behavior Analyst (LBA) is required where mandated by state regulations.

• Experience in ABA treatment is preferred.

• Strong computer proficiency is preferred.

• Excellent written and verbal communication abilities are preferred.

• Experience in auditing and quality assurance (QA) is preferred.

• Experience collaborating with providers and healthcare teams to review care services related to Applied Behavior Analysis Services is preferred.

• Independent licensure with ABA experience and BCBA certification is preferred.

🏝️ Benefits

• Health insurance.

• 401K plan.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off.

• Holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.

• Equal opportunity employer committed to diversity.